Medical gases and long-term oxygen therapy: reducing the chronic obstructive pulmonary disease burden in aging populations in Sub-Saharan Africa.

Overview

Chronic obstructive pulmonary disease represents a major global health challenge with disproportionate impact on aging populations in low- and middle-income countries, particularly Sub-Saharan Africa. The region experienced a 117 percent increase in prevalent COPD cases across all age groups between 1990 and 2019, reaching 10.3 million cases. Primary drivers include tobacco smoking, biomass fuel exposure, and indoor air pollution, with rural households relying heavily on biomass fuels for cooking and heating. Additional risk factors encompass low birth weight, malnutrition, severe childhood respiratory infections, occupational exposures, outdoor pollution, human immunodeficiency virus, and tuberculosis. Despite escalating prevalence, COPD remains significantly underdiagnosed and undertreated in Sub-Saharan Africa due to inadequate healthcare infrastructure, resource constraints, and limited access to affordable inhaled medications. The aging demographic compounds this burden as COPD correlates strongly with older age. Medical gases, particularly long-term oxygen therapy, constitute essential interventions for managing severe hypoxemia in COPD patients. Evidence from pivotal 1980s studies established that long-term oxygen therapy administered 15 to 24 hours daily reduces mortality compared to no oxygen therapy. The therapy improves survival rates, alleviates breathlessness, enhances sleep quality, and reduces pulmonary hypertension by maintaining oxygen saturation levels. While long-term oxygen therapy is well-established in high-income countries, its implementation in resource-limited settings faces significant barriers including limited access, cost constraints, and insufficient awareness among healthcare providers and patients.

Methods and approach

This review synthesizes evidence on COPD management, long-term oxygen therapy benefits, healthcare policies, and aging demographics in Sub-Saharan Africa. The analysis focuses on experimental studies and data synthesis for coherence. Relevant articles in English published between 2014 and 2025 were retrieved from PubMed, Scopus, and World Health Organization databases. The review examines the epidemiology of COPD in Sub-Saharan Africa, challenges of integrating long-term oxygen therapy into existing healthcare systems, and successful case studies from comparable regions. The analysis encompasses infrastructure gaps, cost barriers, accessibility issues, and policy frameworks relevant to medical gas therapy implementation. The review identifies key opportunities for addressing implementation gaps through comprehensive examination of clinical evidence, healthcare delivery systems, and regional health priorities tailored to the unique needs of Sub-Saharan Africa.

Key Findings

The review identifies medical gases as critical components in COPD management, with oxygen delivered through nasal cannulas or masks to manage hypoxemia, helium-oxygen mixtures used in acute exacerbations to reduce airway resistance, and carbon dioxide occasionally administered to stimulate respiratory drive in patients with COPD-induced hypoventilation. Long-term oxygen therapy emerges as the cornerstone of medical gas therapy, significantly improving quality of life and prognosis for patients with chronic hypoxemia when regular monitoring ensures optimal benefits and minimizes risks such as hypercapnia in carbon dioxide-retaining individuals. The analysis reveals that Sub-Saharan Africa faces substantial barriers to long-term oxygen therapy implementation despite established clinical benefits. The estimated COPD prevalence in low- and middle-income countries reaches 7.2 percent, adversely affecting physical function, quality of life, and socioeconomic well-being. Inadequate understanding of COPD among populations, healthcare professionals, and policymakers intensifies the burden, resulting in poor treatment compliance and heightened patient suffering. The review documents that nearly 80 percent of global COPD cases occur in low- and middle-income countries, with heightened exposure to risk factors including malnutrition, air pollution, and smoking contributing to elevated prevalence.

Implications

The findings underscore the necessity for strengthening healthcare infrastructure, fostering policy frameworks for long-term oxygen therapy integration, leveraging community engagement, and enhancing patient education to address the growing COPD burden in Sub-Saharan Africa. Mitigating the escalating burden requires strengthening prevention strategies, diagnostic capabilities, and access to treatment in primary care environments, alongside increasing awareness and educating healthcare professionals and communities. The review emphasizes that addressing these challenges holistically through regional and global collaborations can mitigate the growing burden of COPD and improve health outcomes for aging populations. Implementation strategies must consider the unique context of resource-limited settings where inadequate healthcare infrastructure and absence of affordable inhaled medications compound treatment challenges. The evidence supports the clinical importance of medical gases in reducing COPD morbidity and mortality while highlighting the urgency of developing evidence-based recommendations to inform policy, healthcare strategies, and research priorities. Enhanced awareness, refined diagnostic methods, and targeted preventative initiatives emerge as essential components for addressing this escalating health issue in aging populations across Sub-Saharan Africa.